Provider Demographics
NPI:1114918448
Name:SKINDELL, ROGER A (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:SKINDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1254 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1343
Practice Address - Country:US
Practice Address - Phone:810-664-4531
Practice Address - Fax:810-667-7337
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA080D410020OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherBLUE CHOICE POS
MI3303942Medicaid
MIB43804OtherHEALTH NET FEDERAL SERV
MI201552OtherHEALTH ADVANTAGE NETWORK
MI2999842001OtherCIGNA
MI080095523OtherMETRAHEALTH
MI080D410020OtherCOMMUNITY BLUE
MI5440026OtherHEALTH PLUS
MIB43804OtherHEALTH ALLIANCE PLAN
MI080D410020OtherBLUE CARE NETWORK
MA4120730OtherAETNA
MI201552OtherMCLAREN HEALTH PLAN
MIC1538OtherMCARE
MIB43804OtherHEALTH ALLIANCE PLAN
MI201552OtherMCLAREN HEALTH PLAN
MI3303942Medicaid